Clinical profile of patients with uterine rupture at a tertiary facility in North Central Nigeria
Main Article Content
Abstract
Background: Uterine rupture is a major obstetric emergency and an important cause of maternal and perinatal morbidity and mortality.
Aim: To determine the prevalence, clinical presentation, management options and pregnancy outcomes following uterine rupture.
Methods: It is a 5-year, descriptive, retrospective study of parturients who had uterine rupture between 1 January 2011 and 31 December, 2015, at Federal Medical Centre, Bida, North Central Nigeria. The case files of all parturients who had uterine rupture during this period were retrieved from the Medical Records department, and relevant information including maternal age, risk factors for uterine rupture, presenting symptoms, site of rupture and the definitive treatment as well as maternal and neonatal outcome using a data collection sheet was entered into a computer with SPSS version 20.0, which was also used for the analysis.
Results: The prevalence of uterine rupture was 1 in 202 deliveries (48/9,718); of these, 24 (50.0%) were aged 36–40 years and 28 (58.3%) were grandmultipara (parity ≥5); 42 (87.5%) cases had previous uterine scar, whereas 15 (31.3%) had labour augmentation with oxytocin while attempting vaginal birth after caesarean section. The common presenting complaints were intrapartum vaginal bleeding (24; 50%) and abdominal pain (10; 20.8%). The most common site of rupture was anterolateral (24; 50.0%), while the most common surgical intervention was uterine repair with bilateral tubal ligation (30; 62.5%). The case fatality rate was 18.8% (9/48), neonatal survival rate was 12.5% (6/48) and perinatal mortality rate was 875/1000 deliveries (42/48).
Conclusion: Uterine rupture remains an important cause of poor pregnancy outcomes in low-income settings. Previous caesarean delivery is the most common risk factor; women attempting vaginal birth after caesarean delivery should be managed by skilled health personnel in facilities with provision for emergency surgical intervention.
Downloads
Article Details
The journal grants the right to make small numbers of printed copies for their personal non-commercial use under Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License.
References
1. Orhue AA. Problems of labour. In: Agboola A, editor. Textbook of Obstetrics and Gynaecology for Medical Students. 2nd ed. Lagos: Heinemann Educational Books Nigeria. Plc, 2006; 442‑71.
2. Amanad G, Mengiste M. Ruptured uterus: eight year retrospective analysis of causes and management outcome in Adigrat Hospital, Tigray Region. Ethiop J Health Dev 2002;16:241‑5.
3. Ogunnowo T, Olayemi O, Aimakhu CO. Uterine rupture: UCH, Ibadan experience. West Afr J Med 2003;22:236‑9.
4. Eze JN, Anozie OB, Lawani OL, Ndukwe EO, Agwu UM, Obuna JA, et al. Evaluation of obstetricians’ surgical decision making in the management of uterine rupture. BMC Pregnancy Childbirth 2017;17:179.
5. Eguzo KN, Lawal AK, Ali F, Umezurike CC. Patterns of uterine rupture in Nigeria: A comparative study of scarred and unscarred uterus. Int J Reprod Contracept Obstet Gynecol 2015;4:1094‑9.
6. Adegbola O, OdeseyeAK. Uterine rupture at Lagos Teaching Hospital. J Clin Sci 2017;14:13‑7.
7. Esike CO, Aluka CO, Okali UK, Twomey DE. Contributions of scarred uterus to ruptured uterus in rural Nigeria. Int J Reprod Contracept Obstet Gynecol 2016;5:1790‑5.
8. Motomura K, Ganchimeg T, Nagata C, Ota E, Vogel JP, Betran AP, et al. Incidence and outcomes of uterine rupture among women with
prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health. Sci Rep 2017;7:44093.
9. Danso KA. Ruptured uterus. In: Kwawukume EY, Emuveyan EE, editors. Comprehensive Gynaecology in the Tropics. Accra: Graphic Package, 2005; 86‑92.
10. Ahmed Y, Shehu CE, Nwobodo EI, Ekele BA. Reducing maternal mortality from ruptured uterus – The Sokoto initiative. Afr J Med Med Sci 2004;33:135‑8.
11. Dhaifalah I, Santavy J, Fingerova H. Uterine rupture during pregnancy and delivery among women attending the Al‑Tthawra Hospital in
Sana’a city Yemen Republic. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2006;150:279‑83.
12. Revicky V, Muralidhar A, Mukhopadhyay S, Mahmood T. A case series of uterine rupture: Lessons to be learned for future clinical practice.
J Obstet Gynaecol India 2012;62:665‑73.
13. Fitzpatrick KE, Kurinczuk JJ, Alfirevic Z, Spark P, Brocklehurst P, Knight M, et al. Uterine rupture by intended mode of delivery in the UK: A national case‑control study. PLoS Med 2012;9:e1001184.
14. Ibekwe PC. Ruptured uterus in a primigravida: A case report. Trop J Obstet Gynaecol 2002;19:47‑8.
15. Al Sakka M, Hamsho A, Khan L. Rupture of the pregnant uterus – A 21‑year review. Int J Gynaecol Obstet 1998;63:105‑8.
16. Scearce J, Uzeka PS. Current Diagnosis and Treatment in Obstetrics and Gynaecology. 10th ed. New York: Mcgraw Hill, 2007; 339‑41.
17. Al‑Zirqi I, Stray‑Pedersen B, Forsén L, Vangen S. Uterine rupture after previous caesarean section. BJOG 2010;117:809‑20.
18. Manoharan M, Wuntakal R, Erskine K. Uterine rupture: A revisit. Obstet Gynaecol 2010;12:223‑30.
19. Ojenuwah SA, OlowosuluRO. Surgical management of ruptured gravid uterus in Bida, North Central Nigeria. Trop Doct 2007;37:219‑21.